Healthcare Provider Details

I. General information

NPI: 1942583547
Provider Name (Legal Business Name): STEPHANIE KOTZUR ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N SAM HOUSTON PKWY E STE 516
HOUSTON TX
77060-5915
US

IV. Provider business mailing address

650 N SAM HOUSTON PKWY E STE 516
HOUSTON TX
77060-5915
US

V. Phone/Fax

Practice location:
  • Phone: 281-620-6761
  • Fax:
Mailing address:
  • Phone: 832-456-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number716688
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: